Individual
KATY TARA LANDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, ED. S., LEP#4191
Contact information
Practice address
8880 RIO SAN DIEGO DR FL 8, SAN DIEGO, CA 92108-1642
(619) 500-6282
Mailing address
8880 RIO SAN DIEGO DR FL 8, SAN DIEGO, CA 92108-1642
(619) 500-6282
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
4191
CA
103TM1800X
Intellectual & Developmental Disabilities Psychologist
4191
CA
103TS0200X
School Psychologist
Primary
4191
CA
Other
Enumeration date
09/28/2023
Last updated
09/28/2023
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